| NPI | 1013966704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME34257) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL me34257) |
| 208D00000X General Practice (Licence: FL ME34257) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2019-09-25 |