| NPI | 1902330095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: TX T8507) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX T8507) |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2023-03-28 |