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 |