| NPI | 1730405523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: TN MD54000) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: CO 0052549) |
| 208000000X Pediatrics (Licence: TN MD54000) | |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2022-03-31 |