| NPI | 1295181154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301018918) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20042942A) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2021-08-18 |