| NPI | 1871755157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics Sports Medicine (Licence: AZ 007096) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34009782) |
| 2080P0204X Pediatrics Pediatric Emergency Medicine (Licence: OH 34009782) | |
| 2080S0010X Pediatrics Sports Medicine (Licence: OH 34009782) | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2024-01-19 |