| NPI | 1417065558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: ME MD16483) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: ME MD16483) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2021-11-08 |