| NPI | 1902908296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME107312) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH 35-04-1086) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2014-01-08 |