| NPI | 1114959657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: MA 229233) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 229233) |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: MA 229233) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2011-05-03 |