| NPI | 1730169715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: LA MD.204350) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: VA 0101-235627) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2020-12-28 |