| NPI | 1740525203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0216X Pediatrics, Pediatric Rheumatology (Licence: TX P6403) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: TX P6403) |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2021-05-10 |