| NPI | 1215946215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: PA MD062249L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 25MA06587600) |
| 208000000X Pediatrics (Licence: PA MD062249L) | |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: NJ 25MA06587600) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2018-12-03 |