| NPI | 1386675601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0030248) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD D0030248) |
| 103TC1900X Psychologist, Counseling (Licence: MD D0030248) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD D0030248) | |
| 103TF0000X Psychologist, Family (Licence: MD D0030248) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2023-07-15 |