| NPI | 1518053677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME 72452) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME 72452) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-07-08 |