| NPI | 1629569504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A173995) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2024-01-26 |