| NPI | 1265536809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME41146) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0041146) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2015-12-04 |