| NPI | 1851560403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: MD D67299) |
| Additional Taxonomies | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: MD D67299) |
| 208000000X Pediatrics (Licence: MD D67299) | |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2009-10-13 |