| NPI | 1992879159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 21329) |
| Additional Taxonomies | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: CO 21329) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2023-03-07 |