NPI | 1639167513 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME87988) |
Additional Taxonomies | 174400000X Specialist (Licence: FL ME87988) |
Enumeration Date | 2005-10-13 |
Last Update Date | 2021-04-12 |