| NPI | 1407183353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: MA 247169) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 247169) |
| 208000000X Pediatrics (Licence: AZ R70720) | |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2021-09-23 |