| NPI | 1912905944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: MA 73263) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: MA 73263) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2010-09-09 |