| NPI | 1073506333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: SC 12114) |
| Additional Taxonomies | 2080P0008X Pediatrics Neurodevelopmental Disabilities (Licence: SC 12114) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2007-07-08 |