| NPI | 1639431083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 70997) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME124734) |
| 208M00000X Hospitalist (Licence: FL ME124734) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2023-08-25 |