| NPI | 1972529170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA C159183) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 30604) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2019-01-22 |