| NPI | 1689994972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME128243) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 258377) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: FL ME128243) | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2023-04-03 |