| NPI | 1164837514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: TX S1546) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT207580) |
| 208000000X Pediatrics (Licence: TX S1546) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: PA MT207580) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2022-07-26 |