| NPI | 1215992292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: MN 48608) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 47394) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35.094808) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2023-06-12 |