| NPI | 1730217548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: KY 46496) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 46496) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2018-09-14 |