| NPI | 1003226986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN 3619) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 4492) |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2023-04-10 |