| NPI | 1548427420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: NJ 25MA09525800) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: PA MT198441) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2014-07-16 |