| NPI | 1033130588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO R2J74) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: MO R2J74) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: MO R2J74) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2007-07-12 |