| NPI | 1902910649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G88993) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME 40538) |
| 2084P0805X (Licence: FL ME 40538) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2024-06-18 |