| NPI | 1316929722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20040964A) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY KY-1066) |
| Enumeration Date | 2005-11-19 |
| Last Update Date | 2008-01-14 |