| NPI | 1477819241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: TX Q4928) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX Q4928) |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: TX Q4928) | |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2018-08-07 |