| NPI | 1528011582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: PA MD058800L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2008-01521) |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: NC 2008-01521) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2024-09-04 |