| NPI | 1851473078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 4917) |
| Additional Taxonomies | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: PR 4917) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2007-07-08 |