NPI | 1386875938 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME142246) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 6042) |
Enumeration Date | 2009-07-30 |
Last Update Date | 2021-07-06 |