| NPI | 1902031149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 55472) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 55472) |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2020-10-14 |