| NPI | 1396779054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: FL ME65142) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 25MA08127000) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 227487) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NJ 25MA08127000) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: FL ME136452) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: FL ME65142) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-07-17 |