| NPI | 1649585944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME152534) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME152534) |
| 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: FL ME152534) | |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2023-10-23 |