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 |