| NPI | 1093730228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA PS004775L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS004775L) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2012-10-08 |