| NPI | 1730729047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: MD 06215) |
| Additional Taxonomies | 1835P1300X Pharmacist Psychiatric (Licence: MD 17726) |
| Enumeration Date | 2020-01-14 |
| Last Update Date | 2021-05-11 |