| NPI | 1164588331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: VA 0101248738) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101248738) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2013-10-21 |