| NPI | 1508094749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: CO DR.0060392) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.099747) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35.099747) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2021-04-12 |