| NPI | 1881692291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: CA C177174) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA C177174) |
| Enumeration Date | 2005-07-09 |
| Last Update Date | 2022-07-27 |