| NPI | 1376045468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 242610) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20043301A) |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2020-12-01 |