| NPI | 1134275506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME161613) |
| Additional Taxonomies | 2084P0805X (Licence: MD D0061300) |
| 2084P0805X (Licence: FL ME161613) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2023-06-24 |