| NPI | 1982627691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: VT 0420008397) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VT 0420008397) |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: VT 0420008397) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2013-10-10 |