| NPI | 1710064621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: NY 226592) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: NY 226592) |
| 208000000X Pediatrics (Licence: NY 226592) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-03-26 |