| NPI | 1366949737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME150990) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5315238935) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036163674) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL 150990) | |
| 207Q00000X Family Medicine (Licence: FL ME150990) | |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2023-11-03 |