| NPI | 1356338784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME122053) |
| Additional Taxonomies | 174400000X Specialist (Licence: NH 9668) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2015-03-20 |