| 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 |