| NPI | 1134105612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 9601045) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 9601045) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2019-05-31 |