| NPI | 1902435159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: CA A195707) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A195707) |
| 208000000X Pediatrics (Licence: OH 57.249808) | |
| 208000000X Pediatrics (Licence: OH 35.148154) | |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2024-06-06 |