| NPI | 1013973668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 183438) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: OR 153312) |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: NY 183438) | |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2011-01-11 |