| NPI | 1740008028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC MD93270) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC MD93270) |
| Enumeration Date | 2024-09-26 |
| Last Update Date | 2024-09-26 |