| NPI | 1093705790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME90082) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital (Licence: FL ME90082) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2016-10-20 |