| NPI | 1174799761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MT MED-PHYS-LIC-50435) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME115111) |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2020-02-06 |