| NPI | 1235397233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: WA md60359462) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57-013928) |
| 208000000X Pediatrics (Licence: WA md60359462) | |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2013-08-01 |