| NPI | 1942234380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: GA 59689) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TN MD39135) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: TN MD39135) | |
| 208000000X Pediatrics (Licence: TN MD39135) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-03-20 |