NPI | 1831439306 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: CA 20A12543) |
Additional Taxonomies | 208000000X Pediatrics (Licence: PA OS017498) |
2080S0010X Pediatrics, Sports Medicine (Licence: TX Q8346) | |
Enumeration Date | 2013-02-21 |
Last Update Date | 2022-12-23 |