NPI | 1376742411 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: SC 29756) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: SC 29756) |
208000000X Pediatrics (Licence: SC 29756) | |
Enumeration Date | 2007-07-17 |
Last Update Date | 2025-06-18 |