| NPI | 1659725489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.136592) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35.136592) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2024-10-21 |