| NPI | 1053637736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: AZ 50745) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 50745) |
| 208000000X Pediatrics (Licence: MA 258848) | |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2023-01-11 |