| NPI | 1851350029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME 83027) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL me83027) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2012-03-08 |