NPI | 1669442612 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: WA MD00046301) |
Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 26988) |
Enumeration Date | 2006-01-24 |
Last Update Date | 2016-05-25 |