| NPI | 1811476906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MA 10844) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2018-09-06 |