| NPI | 1710055223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: AL 28081) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA 35108) |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: IA 35108) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2017-02-16 |