| NPI | 1700859691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: CA A062510) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A062510) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2023-06-28 |