| NPI | 1316981780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: MA 158266) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 158266) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ME 13957) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: ME 13957) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2025-09-11 |