| NPI | 1851771976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX U6267) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: SC MD84563) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2024-10-23 |