| NPI | 1831623222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: OH 34.014390) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34.014390) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2022-07-25 |