| NPI | 1669882676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX R1441) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: OH 57.029124) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: IN 01078341A) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: KY 50455) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: TX R1441) | |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2022-07-21 |