| NPI | 1457558660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: PA MD438847) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD438847) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2024-05-22 |