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 |