| NPI | 1609986025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35.132562) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.132562) |
| 208000000X Pediatrics (Licence: WA MD6005114) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: WA md60051104) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2017-11-17 |