| NPI | 1811016058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 38842) |
| Additional Taxonomies | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: FL ME 89219) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2009-08-31 |