| NPI | 1144312638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME69838) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital (Licence: FL ME69838) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2020-10-16 |