| NPI | 1629180856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME0047042) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: FL Me0047042) |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: FL ME0047042) | |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: FL ME0047042) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2007-07-08 |