| NPI | 1245393024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NC 39443) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 39443) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2025-09-11 |