| NPI | 1962471169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME48902) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0048902) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2020-02-24 |