| NPI | 1578565289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101238268) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: HI 7890) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2014-02-11 |