| NPI | 1891825568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME100494) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 25834) |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: FL ME100494) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2014-10-01 |