| NPI | 1386747277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX L0052) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX L0052) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2015-12-08 |