| NPI | 1558539973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 201835) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 1508365) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: LA 201835) | |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2022-06-28 |