| NPI | 1114925138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 36020) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NH 9803) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ME 014771) | |
| 2084P0805X (Licence: MA 36020) | |
| 2084P0805X (Licence: NH 9803) | |
| 2084P0805X (Licence: ME 014771) | |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2021-02-16 |