| NPI | 1679611750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A023530) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA A023530) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2009-09-21 |