NPI | 1902435159 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: FL ME175069) |
Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.249808) |
208000000X Pediatrics (Licence: OH 35.148154) | |
2080S0010X Pediatrics, Sports Medicine (Licence: CA A195707) | |
208000000X Pediatrics (Licence: CA A195707) | |
Enumeration Date | 2020-04-08 |
Last Update Date | 2025-08-25 |