| NPI | 1417416389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX V4500) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: FL ME150387) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME150387) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2024-12-03 |