| NPI | 1598727307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 27321) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: MN 27321) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2020-07-28 |