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 |