| NPI | 1629200647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME114528) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: WV 18258) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD070752L) | |
| Enumeration Date | 2009-08-10 |
| Last Update Date | 2014-08-25 |