| NPI | 1245877802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NH 1663) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: GA 004353) |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2023-08-28 |