| NPI | 1922530377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME151032) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: FL ME151032) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2023-03-01 |