NPI | 1164803375 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: TX S6061) |
Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 007585) |
208000000X Pediatrics (Licence: TX S6061) | |
Enumeration Date | 2015-06-12 |
Last Update Date | 2025-08-19 |