| NPI | 1912195017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL me107982) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME107982) |
| 207R00000X Internal Medicine (Licence: FL ME107982) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME107982) | |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2020-07-01 |