| NPI | 1942234919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CT 031792) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: CT 031792) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2011-10-18 |