| NPI | 1417164013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: PR 015928) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME103777) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL 103777) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2025-08-06 |