| NPI | 1417248923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX P8953) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: TX P8953) |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2023-09-28 |