| NPI | 1255478921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL 80436) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G84196) |
| 208000000X Pediatrics (Licence: TN 64773) | |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: FL 46751) | |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: CA G84196) | |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: TX ME 80436) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2023-01-30 |