| NPI | 1205800463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CT 028276) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CT 028276) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2015-10-27 |