| NPI | 1003830563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MS 41677) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MS 41677) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2015-12-08 |