| NPI | 1285715540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: WA MD00005459) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00005459) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2009-02-12 |