| NPI | 1669515730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME55324) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME55324) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2021-09-15 |