| NPI | 1275614869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist Health Service (Licence: IN 20010366 HSPP) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IN 20010366 HSPP) |
| 103TC0700X Psychologist Clinical (Licence: IN 20010366 HSPP) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2008-01-07 |