| NPI | 1386014892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NE 892) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NE 300514) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2016-04-26 |