| NPI | 1194014290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: NE 963) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 963) |
| 208D00000X General Practice (Licence: NE 963) | |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2020-08-27 |