| NPI | 1134534365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101269203) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0101269203) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2021-07-16 |