| NPI | 1639342074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: FL ME 105037) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 061363) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME 105037) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH 35.135772) | |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2022-08-16 |