| NPI | 1194756031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME55240) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME55240) |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: FL ME55240) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2023-03-07 |