| NPI | 1952355471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX R0192) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: RI 09645) |
| 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: TX R0192) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2024-08-09 |