| NPI | 1265782668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 77376) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR MD227931) |
| 101Y00000X Counselor | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A164365) | |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2025-10-20 |