| NPI | 1164755328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NV 9427) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NV 9427) |
| Enumeration Date | 2009-09-04 |
| Last Update Date | 2023-03-16 |