| NPI | 1164452272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: GA 040295) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: GA 040295) |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AL MD27678) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2024-12-30 |