| NPI | 1316941339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ME 1365) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: ME 1365) |
| 208D00000X General Practice (Licence: ME 1365) | |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2007-12-11 |