NPI | 1083608079 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: WI 31022) |
Additional Taxonomies | 208000000X Pediatrics (Licence: WI 31022) |
Enumeration Date | 2005-09-06 |
Last Update Date | 2008-09-09 |