NPI | 1639103161 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: MS 36-600) |
Additional Taxonomies | 208000000X Pediatrics (Licence: MS 36-600) |
Enumeration Date | 2006-07-10 |
Last Update Date | 2008-08-04 |