| NPI | 1164719498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: CA A62686) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A62686) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2011-07-07 |