| NPI | 1790908564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL MD 97580) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME 97580) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101271011) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2020-04385) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: FL ME 97580) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2021-05-12 |