| NPI | 1922054030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: FL ME118424) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 31988) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2016-08-11 |