| NPI | 1508840463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: KY 23449) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 23449) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2013-01-04 |