| NPI | 1447335252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: WA MD00033336) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00033336) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2009-02-05 |