NPI | 1497740039 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: CO 30494) |
Additional Taxonomies | 208000000X Pediatrics (Licence: CO 30494) |
Enumeration Date | 2005-09-20 |
Last Update Date | 2013-01-22 |