| NPI | 1194875625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 09052R) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 09052R) |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: LA 09052R) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2022-02-16 |