| NPI | 1942613062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: HI DOS1706) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: HI DOS1706) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2025-09-08 |