| NPI | 1184612426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME128560) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 0101043448) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2023-07-11 |