| NPI | 1932314804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35-091938) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: OH 35.091938) |
| Enumeration Date | 2007-05-13 |
| Last Update Date | 2013-08-08 |