| NPI | 1538103346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: VA 0101052850) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101052850) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: VA 0101052850) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-08-23 |