NPI | 1285607663 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: OK 13868) |
Additional Taxonomies | 208000000X Pediatrics (Licence: OK 13868) |
Enumeration Date | 2006-02-08 |
Last Update Date | 2016-09-20 |