| NPI | 1154362556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME72134) |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: FL ME72134) |
| 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: FL ME72134) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2018-07-13 |