| NPI | 1023118361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: ME MD18561) |
| Additional Taxonomies | 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: VT 42-0010939) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2019-05-08 |