| NPI | 1093009219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ME MD25052) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042.0013745) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2021-09-20 |