| NPI | 1245393529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D48079) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 03283) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2013-12-04 |