| NPI | 1922392166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MT199483) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: PA MT199483) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2014-06-25 |