| NPI | 1043309586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY9783) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20040752A) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2023-08-09 |