| NPI | 1477521318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: WA 60567453) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD60567453) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2024-10-22 |