| NPI | 1316053903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NE 22058) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2023-09-05 |