| NPI | 1528040458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: GA 42395) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: NC 39336) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2020-10-16 |