| NPI | 1356787089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ME DO2802) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 0054661) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: CT 054661) | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2018-11-12 |