| NPI | 1093784241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 31269) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: WI 31269) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2026-07-09 |