| NPI | 1104359058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME162519) |
| Additional Taxonomies | 2085N0700X (Licence: FL ME162519) |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2025-10-17 |