| NPI | 1043266638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: MO 31258) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 31258) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2021-11-15 |