| NPI | 1528060068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0008X Pediatrics Neurodevelopmental Disabilities (Licence: NY 282145) |
| Additional Taxonomies | 174400000X Specialist (Licence: NE 19840) |
| 2080P0008X Pediatrics Neurodevelopmental Disabilities (Licence: NC 2008-01446) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2016-04-05 |