| NPI | 1407168404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: NC 2016-01586) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2016-01586) |
| 208000000X Pediatrics (Licence: SC LL32762) | |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2020-10-26 |