| NPI | 1548623515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 309286) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL TRN 20218) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME130637) | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2022-05-12 |