| NPI | 1467516716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: IL 036116391) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.092389) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35.092389) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2021-09-27 |