| 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 |