NPI | 1154496057 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: NY 194142) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NY 194142) |
Enumeration Date | 2006-11-24 |
Last Update Date | 2022-06-03 |