| NPI | 1386688828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 73331) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: MA 73331) |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: MA 73331) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-03-05 |