| NPI | 1760639983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A127136) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301092684) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: CA A127136) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301092684) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2018-07-10 |