| NPI | 1336534338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 20A17197) |
| Additional Taxonomies | 2080S0010X Pediatrics Sports Medicine (Licence: CA 20A17197) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2019-06-19 |