| NPI | 1619095916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD016736E) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: PA MD016736E) |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: PA MD016736E) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-08 |