| 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 |