| NPI | 1265516793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME169357) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME169357) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2024-09-19 |