| NPI | 1225153752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: FL ME110990) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35 077290) |
| 208000000X Pediatrics (Licence: FL ME110990) | |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: OH 35.077290) | |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: OH 35 077290) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2024-07-22 |