| NPI | 1437128667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301057010) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MI 4301057010) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: MI 4301057010) | |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2008-10-02 |