| NPI | 1093920266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VT 042-0011414) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ME 016683) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2012-06-27 |