| NPI | 1225006984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WI 72285) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD027820L) |
| 2080S0010X Pediatrics Sports Medicine (Licence: PA MD027820L) | |
| 208M00000X Hospitalist (Licence: PA MD027820L) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2019-12-02 |