| NPI | 1598825358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KY 30676) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2014-11-04 |