| NPI | 1033558929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL me131705) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 756) |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: FL ME131705) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME131705) | |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2020-09-29 |