| NPI | 1336101104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: ME 014097) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: ME 014097) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2022-08-09 |