| NPI | 1235204140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine (Licence: AR C-7255) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR C-7255) |
| 2080S0010X Pediatrics Sports Medicine (Licence: AR C-7255) | |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2007-07-31 |