| NPI | 1841282845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: MA 80199) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: MI 4301032077) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2007-07-08 |