| NPI | 1265850341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics Developmental - Behavioral Pediatrics (Licence: FL ME144012) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 55975) |
| 208000000X Pediatrics (Licence: FL ME144012) | |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2020-08-19 |