| NPI | 1821053760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: AL 23180) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AL 23180) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2014-09-30 |