| NPI | 1588753255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 48391) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 48391) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2014-11-24 |