NPI | 1639197494 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: MS 23389) |
Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AL 27417) |
208000000X Pediatrics (Licence: SC 24443) | |
Enumeration Date | 2006-07-18 |
Last Update Date | 2014-12-15 |