| NPI | 1043256605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME121882) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 21637-020) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 2007-01213) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2016-12-29 |