| NPI | 1669633160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: MO 2017033689) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 05-35684) |
| 208000000X Pediatrics (Licence: MO 2017033689) | |
| 2080S0010X Pediatrics, Sports Medicine (Licence: KS 05-35684) | |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2017-10-30 |