| NPI | 1710013990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME62364) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0062634) |
| Enumeration Date | 2007-02-24 |
| Last Update Date | 2017-11-16 |