| NPI | 1093792392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2009038103) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20041042A) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2010-02-11 |