| NPI | 1275646291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME120624) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 043101) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35121424) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2014-09-23 |