| NPI | 1992124341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: IA MD-46549) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA MD-46549) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: IA MD-46549) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2023-02-14 |