| NPI | 1972335099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: TN 4009) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: TN 4009) |
| Enumeration Date | 2024-08-16 |
| Last Update Date | 2024-10-03 |