| NPI | 1063574994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: IN 20090164A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IN 35000590A) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2009-08-17 |