| NPI | 1194791392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME115004) |
| Additional Taxonomies | 2084P0805X (Licence: FL ME115004) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2022-06-01 |