| NPI | 1669426490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: TX H3784) |
| Additional Taxonomies | 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: TX H3784) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2019-03-19 |