NPI | 1790929396 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: CA C40168) |
Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: LA MD.012864) |
Enumeration Date | 2009-04-27 |
Last Update Date | 2009-12-02 |