| NPI | 1356835664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: GA 96557) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301115577) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35.144769) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2023-08-07 |