| NPI | 1689608655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: CA A062992) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A062992) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2025-09-11 |