| NPI | 1063453637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 016175) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20044067A) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2026-04-01 |