NPI | 1740218155 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: CA A91588) |
Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA A91588) |
Enumeration Date | 2006-06-28 |
Last Update Date | 2019-01-22 |