| NPI | 1568491272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: TX Q8696) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX Q6896) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2024-03-26 |