| NPI | 1376514398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NE 36823) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: NE 36823) |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2026-06-24 |