| NPI | 1124348263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IA 40021) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IA R-8850) |
| 2084F0202X Psychiatry & Neurology Forensic Psychiatry (Licence: FL ME119228) | |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2014-08-29 |