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 |