| NPI | 1306054077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: IL 036118363) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036118363) |
| 208M00000X Hospitalist (Licence: IL 036118363) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2022-09-27 |