| NPI | 1356520647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: ME MD17607) |
| Additional Taxonomies | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: ME 017607) |
| 261QM2800X Clinic/Center, Methadone Clinic (Licence: ME MD17607) | |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2023-01-02 |