| NPI | 1467347666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP BOUCHER Owner 402-382-2978 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207K00000X Allergy & Immunology |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics | |
| Enumeration Date | 2025-06-10 |
| Last Update Date | 2025-07-29 |