| NPI | 1184690612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: ME MD14271) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: ME 014271) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2021-04-08 |