| NPI | 1720187271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G31295) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME 63860) |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: CA G31295) | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: FL ME 63860) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2012-07-31 |