| NPI | 1053305045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: WI 22479) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 22479) |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2011-12-23 |