| NPI | 1376742411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 29756) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: SC 29756) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2018-04-03 |