| NPI | 1083102800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: TX U4324) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: NY 309438) |
| 208000000X Pediatrics (Licence: TX U4324) | |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2023-05-18 |