| NPI | 1407039571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A105648) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA A105648) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2014-10-16 |