| NPI | 1932352754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: KS 04-044755) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57-015275) |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: MO 2018011956) | |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2021-09-02 |