| NPI | 1649361601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NC 9900593) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 9900593) |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: NC 9900593) | |
| 2086S0120X Surgery, Pediatric Surgery (Licence: NC 9900593) | |
| 208D00000X General Practice (Licence: NC 9900593) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2018-11-27 |