| NPI | 1558325456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA G34236) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: CA G34236) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2007-09-12 |