| NPI | 1386674182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: OK 20370) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OK 20370) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: OK 20370) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2013-07-29 |