| NPI | 1114901840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 43010545) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 4301054556) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2022-06-13 |