NPI | 1497014765 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME121113) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL TRN19627) |
Enumeration Date | 2012-05-08 |
Last Update Date | 2024-09-13 |