| NPI | 1134159387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MS 10135) |
| Additional Taxonomies | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: MS 10135) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2012-06-13 |