| NPI | 1972709012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083S0010X Preventive Medicine, Sports Medicine (Licence: PR 18523) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: PR 18523) |
| 2083S0010X Preventive Medicine, Sports Medicine (Licence: NJ 25MA08776600) | |
| 208000000X Pediatrics (Licence: PR 18523) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2020-07-28 |