| 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 |