| NPI | 1700873825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AL MD.7394) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AL 00007394) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2022-04-19 |