| NPI | 1255650081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME130503) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME130503) |
| 207Q00000X Family Medicine (Licence: NC 2014-01754) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2014-01754) | |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2023-04-18 |