| NPI | 1881666055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: CA 20A18160) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0102201067) |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: VA 0102201067) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2020-08-18 |