| NPI | 1063595593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AL 3042) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA 3331) |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: AL 3042) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2024-02-26 |