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 |