| NPI | 1720286271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: MO 2011021435) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: KS 0435150) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2025-11-06 |