| NPI | 1992775209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: CA C52893) |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: LA MD.018896) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2019-07-02 |