| NPI | 1457491714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME69037) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL ME69037) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA ME69037) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2018-01-02 |