| NPI | 1750607768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL ME123254) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A121412) |
| 208000000X Pediatrics (Licence: FL ME123254) | |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2015-06-29 |