| NPI | 1528023504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IA 39155) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: WI 48969) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2010-09-27 |