| NPI | 1982699245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: TX V4712) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35060722) |
| 208000000X Pediatrics (Licence: TX V4712) | |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: OH 35-060722) | |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2025-08-25 |