| NPI | 1427212794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 30568) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: CA G28966) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2022-05-13 |