| NPI | 1679824312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: ME 014552) |
| Additional Taxonomies | 171100000X Acupuncturist |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2012-09-20 |