| NPI | 1376547612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: CA G137323) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G137323) |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: MA 55590) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2024-04-08 |