| NPI | 1710205018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: TX P5844) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX P5844) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2015-05-21 |