| NPI | 1295783769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA MD.200395) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: LA MD.200395) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2016-11-10 |