| NPI | 1376767988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME157729) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 238710) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 238710) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2022-09-01 |