| NPI | 1144335563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS14006) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY6977) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2016-05-23 |