| NPI | 1649474511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD60294697) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: WA MD60294697) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2022-07-21 |