| NPI | 1629085675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics Sports Medicine (Licence: MO 2006031060) |
| Additional Taxonomies | 2080S0010X Pediatrics Sports Medicine (Licence: KS 04-32152) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2015-07-16 |