| NPI | 1083813687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: CA A108088) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A108088) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2021-07-27 |