| NPI | 1952692097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME140343) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD451866) |
| Enumeration Date | 2011-04-24 |
| Last Update Date | 2023-03-07 |