| NPI | 1164514840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20042189) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IN 99023416A) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2008-08-01 |