| NPI | 1083265854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IN 20043288A) |
| Additional Taxonomies | 103TP2701X Psychologist Group Psychotherapy (Licence: IN 20043288A) |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2019-09-24 |