| NPI | 1497469134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL TRN42144) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: FL PN5189468) |
| 364SP0810X Clinical Nurse Specialist, Psych/Mental Health, Child & Family (Licence: FL PN5189468) | |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2025-05-22 |