| NPI | 1265542856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 99027535) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IN 39000197A) |
| 106H00000X Marriage & Family Therapist (Licence: IN 35000428A) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2024-06-01 |