| NPI | 1558510511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME127279) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: FL ME127279) |
| 282N00000X General Acute Care Hospital (Licence: FL ME127279) | |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2022-07-21 |