| NPI | 1568402436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 03159) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MD 03159) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2013-07-10 |