| NPI | 1417188319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME130572) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18570) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2018-07-17 |