| NPI | 1851358030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: WA 60954756) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01061661A) |
| 208000000X Pediatrics (Licence: WA 60954756) | |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: TX V5138) | |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: ID 4071469) | |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: AK 230508) | |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: IN 01061661A) | |
| Enumeration Date | 2006-04-29 |
| Last Update Date | 2025-05-23 |