| NPI | 1750400412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0016399) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD D16399) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2017-01-11 |