| NPI | 1437543022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: CA A146804) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A146804) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2024-07-24 |