| NPI | 1275314650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 40095) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: IN 20043709B) |
| Enumeration Date | 2023-10-11 |
| Last Update Date | 2024-05-09 |