NPI | 1336638113 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: AZ 72978) |
Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 72978) |
Enumeration Date | 2018-05-07 |
Last Update Date | 2025-02-06 |