| NPI | 1629049853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: MA 220461) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 220461) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2014-12-05 |