| NPI | 1750606067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: NE 26456) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 26456) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2025-07-23 |