| NPI | 1801853783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: SC 13431) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC 13431) |
| 101YM0800X Counselor Mental Health (Licence: SC 13431) | |
| 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry (Licence: SC 13431) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2025-04-22 |