| NPI | 1881681310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: MA 238310) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: RI 10239) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2023-08-15 |