| NPI | 1629193974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME134248) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL #29148) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2021-07-11 |