| NPI | 1497382840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: OH 35.148689) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.148689) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-02-17 |