| NPI | 1649585944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME152534) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MI 4301508015) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY C3081) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101263215) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.120308) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME152534) | |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: FL ME152534) | |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2025-08-27 |