| NPI | 1073862173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KY 260335) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IN 20043503A) |
| 103T00000X Psychologist (Licence: IN 20043503B) | |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2022-11-25 |