NPI | 1194756031 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: FL ME55240) |
Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME55240) |
2080A0000X Pediatrics, Adolescent Medicine (Licence: FL ME55240) | |
Enumeration Date | 2006-07-06 |
Last Update Date | 2025-09-11 |