| NPI | 1417394982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME135955) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC MTXXXXXX) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2025-05-04 |