| NPI | 1528176310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 48969) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 197191) |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: NY 197191) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2013-10-16 |