| NPI | 1528394574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: SC LL83136) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2022-08-12 |