| NPI | 1558780205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 56068) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: AZ 56068) |
| 208000000X Pediatrics (Licence: TX R3476) | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2018-07-11 |