| NPI | 1720269459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: FL ME115625) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME115625) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL ME115625) | |
| Enumeration Date | 2007-11-21 |
| Last Update Date | 2023-03-07 |