| NPI | 1730239971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 259695) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW 19139) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2012-11-29 |