| NPI | 1013060573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 6767) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SC 6767) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2017-10-17 |