| NPI | 1790812568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301089185) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: MI 4301089185) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2010-11-24 |