| NPI | 1013368372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME142847) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL TRN23731) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2020-04284) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101270827) | |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2021-02-08 |