| NPI | 1457432023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 200701656) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC 200701656) |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: MD D0064326) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2021-05-06 |