| NPI | 1225052418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: LA 310957) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MS 09070) |
| 208000000X Pediatrics (Licence: LA 310957) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2018-10-31 |