| NPI | 1942473749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: AZ 47929) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: OH 35.098811) | |
| Enumeration Date | 2008-04-12 |
| Last Update Date | 2018-03-20 |