| NPI | 1063776912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: SC 34854) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 34854) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2021-06-03 |