| NPI | 1730766056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2024024464) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: MO 2024024464) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2026-04-06 |