| NPI | 1578963807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: UT 11734126-1205) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME139029) |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2021-12-20 |