| NPI | 1427315126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME164516) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101262184) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME123938) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: FL ME123938) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: VA 0101262184) | |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2023-10-06 |