| NPI | 1265782668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A164365) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2020-05-05 |