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 |