| NPI | 1518353820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: MA 280645) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 5747) |
| 208000000X Pediatrics (Licence: MA 280645) | |
| 208000000X Pediatrics (Licence: WI 67371) | |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2020-11-23 |