| NPI | 1588647978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 159800-1205) |
| Additional Taxonomies | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: UT 159800-1205) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2010-05-26 |