| NPI | 1255812319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN 3554) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN 3554) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2022-03-23 |