| NPI | 1366470429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: PA MD073748L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DE C10006565) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2016-06-03 |