| NPI | 1073937710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: CA A144064) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A144064) |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2022-07-21 |