| NPI | 1154643120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084E0001X (Licence: FL ME104275) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME104275) |
| Enumeration Date | 2010-02-18 |
| Last Update Date | 2025-06-12 |