| NPI | 1972514081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: VT 6370) |
| Additional Taxonomies | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: NH 6140) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2008-10-28 |