| NPI | 1104217413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5151015439) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2022-05-25 |