| NPI | 1376578336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: FL ME 58216) |
| Additional Taxonomies | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: MA 203612) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2011-10-24 |