| NPI | 1124291885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME100019) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME100019) |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2022-11-03 |