| NPI | 1598755761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME136835) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2022-02-17 |