| NPI | 1801094578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: FL ME105840) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL TRN10998) |
| Enumeration Date | 2007-07-04 |
| Last Update Date | 2013-02-12 |