| NPI | 1679570311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: RI 10341) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: RI MD10341) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2018-10-11 |