| NPI | 1467401992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: HI MD12850) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: HI MD-12850) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2022-04-11 |