| NPI | 1124461546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI MD-18721) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: HI MD-18721) |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2018-02-17 |