| NPI | 1912051558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME0076273) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 184097) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: FL ME0076273) | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: NY 184097) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2017-01-10 |