| NPI | 1679934871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AR E-12608) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MO 2015039823) |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2020-11-18 |