| NPI | 1235198532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.007465) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39001749A) |
| 103TC0700X Psychologist, Clinical (Licence: IN 20042393A) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2023-04-25 |