| NPI | 1154781623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810005365) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: TN 3546) |
| 103T00000X Psychologist (Licence: TN 3546) | |
| 103T00000X Psychologist (Licence: VA 0810005365) | |
| Enumeration Date | 2016-02-26 |
| Last Update Date | 2024-11-28 |