| NPI | 1376557454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME68684) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME68684) |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: FL ME68684) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2017-11-17 |