| NPI | 1447241542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME134987) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16217) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 239492) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PR 16217) | |
| Enumeration Date | 2005-10-30 |
| Last Update Date | 2020-11-17 |