| NPI | 1356548895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME109835) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 002454) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL TRN12587) | |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2013-01-10 |