| 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 |