| NPI | 1558527143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WA MD60916470) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: WA MD60916470) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: IL 036.127218) | |
| 208000000X Pediatrics (Licence: IL 036.127218) | |
| Enumeration Date | 2008-08-02 |
| Last Update Date | 2019-05-16 |