| NPI | 1164699567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: TN 68148) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX 39020000X) |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: TX T4855) | |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2025-07-02 |