| NPI | 1235121468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: VA 0101058154) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101058154) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2015-10-28 |