| NPI | 1306889795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A22430) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA a22430) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2008-02-11 |