| NPI | 1083904155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.120605) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35.120605) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2015-06-03 |