| NPI | 1982799490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 196375) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 196375) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-05-07 |