| NPI | 1538141528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX G9839) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 34096) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2022-02-10 |