| NPI | 1710024005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: UT 12804185-1205) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: CO DR.0044594) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2023-06-25 |