| NPI | 1912168600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX N7537) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: TX N7537) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2016-07-18 |