| NPI | 1912293689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MA 272914) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME120538) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2018-03-17 |