| NPI | 1649767658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 84683) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME169586) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: GA 84683) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: GA 84683) | |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2025-07-11 |