| NPI | 1619974946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME0039317) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL ME003932000) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2019-12-17 |