NPI | 1295295608 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208000000X Pediatrics (Licence: CT 73776) |
Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: CT 73776) |
Enumeration Date | 2019-03-21 |
Last Update Date | 2024-06-13 |