| NPI | 1205092475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME120135) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 241330) |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: FL ME120135) | |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: MA 251690) | |
| 208D00000X General Practice (Licence: PR 26884-R) | |
| 208M00000X Hospitalist (Licence: FL ME120135) | |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2018-06-05 |