| NPI | 1639222664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX L6945) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: TX L6945) |
| Enumeration Date | 2007-01-21 |
| Last Update Date | 2007-07-08 |