| NPI | 1063428639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20042163A) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 057-1860) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2013-03-29 |