| NPI | 1316044456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN MD39223) |
| Additional Taxonomies | 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: TN MD39223) |
| 208000000X Pediatrics (Licence: OH 35059746) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-04-08 |