NPI | 1467650564 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: TX F5723) |
Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: TX F5723) |
Enumeration Date | 2007-07-10 |
Last Update Date | 2012-10-10 |