| NPI | 1477829299 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME128159) | 
| Additional Taxonomies | 208M00000X Hospitalist (Licence: FL ME128159) | 
| Enumeration Date | 2012-03-26 | 
| Last Update Date | 2025-04-15 |