| NPI | 1609432061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A181335) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL TRN28254) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME152291) | |
| 208D00000X General Practice (Licence: FL ME152291) | |
| Enumeration Date | 2019-05-11 |
| Last Update Date | 2022-12-06 |