| NPI | 1871957746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: SC LL92742) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101262858) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2024-08-14 |