| NPI | 1821678111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A182611) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: CA A182611) |
| Enumeration Date | 2021-04-10 |
| Last Update Date | 2026-01-30 |