| NPI | 1700952405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME53467) |
| Additional Taxonomies | 2084P0805X (Licence: FL ME53467) |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: FL ME53467) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2007-08-01 |