| NPI | 1184616948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME120403) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TN 40747) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 017644) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2014-06-26 |