| NPI | 1962474981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 43699) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME132507) |
| 208D00000X General Practice (Licence: MN 43699) | |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2024-05-09 |