| NPI | 1447368493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: PA MD430784) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD430784) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: PA MD430784) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2020-06-23 |