| NPI | 1801424346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics Sports Medicine (Licence: AZ 010269) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 7329) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2024-07-01 |