| NPI | 1013165075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20042635A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39002060A) |
| 103TC0700X Psychologist, Clinical (Licence: IL 071008452) | |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2012-11-28 |