| NPI | 1053400564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IN 20040106A) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |