| NPI | 1013163542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A114671) |
| Additional Taxonomies | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: CA A114671) |
| 208000000X Pediatrics (Licence: IL 125-053642) | |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2020-05-06 |