| NPI | 1720336373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology Geriatric Psychiatry (Licence: FL ME123508) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME123508) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2025-06-14 |