| NPI | 1487829719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics Sports Medicine (Licence: TX N2663) |
| Additional Taxonomies | 2080S0010X Pediatrics Sports Medicine (Licence: CO 46860) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2019-02-01 |