| NPI | 1568409407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME103524) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY7989) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2024-05-15 |