| NPI | 1588624647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: RI MD08996) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 150389) |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: MA MD08996) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2018-06-25 |