NPI | 1710079066 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: MO R3B74) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R3B74) |
Enumeration Date | 2006-09-28 |
Last Update Date | 2019-03-22 |