| NPI | 1144317140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NH 15035) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35-084751) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35-084751) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: NH 15035) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: NH 15035) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2011-06-21 |