| NPI | 1043296361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 200100198) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: NC 200100198) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2016-02-23 |