| NPI | 1609195452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: CA A137057) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2020036607) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2026-03-30 |