| NPI | 1760490239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: OR MD26196) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OR MD26196) |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: MI 4301116723) | |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: OR MD26196) | |
| 2080P0008X Pediatrics, Neurodevelopmental Disabilities (Licence: MI 4301116723) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2023-08-30 |