| 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 |