| NPI | 1467474767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME83254) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME83254) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2014-04-18 |