NPI | 1780203208 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: TX U3291) |
Additional Taxonomies | 208000000X Pediatrics (Licence: TX U3291) |
Enumeration Date | 2020-04-14 |
Last Update Date | 2025-06-13 |