| NPI | 1184817900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IN 20040350A) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY KY-0594) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2008-07-29 |