| NPI | 1063945269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 04684) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: KY 04684) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2020-10-27 |