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 |