NPI | 1841236783 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: MO 2000157927) |
Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2000157927) |
2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MO 2000157927) | |
Enumeration Date | 2006-06-21 |
Last Update Date | 2010-10-19 |