| NPI | 1639289101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: FL ME108713) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME108713) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-05-08 |