| NPI | 1235210725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics Sports Medicine (Licence: FL ME98420) |
| Additional Taxonomies | 207PP0204X Emergency Medicine Pediatric Emergency Medicine (Licence: FL ME98420) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2017-11-10 |