| NPI | 1861782625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AL MD.35176) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: AL 35176) |
| 208000000X Pediatrics (Licence: NM MD2014-0025) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: AL MD.35176) | |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2024-02-01 |