| NPI | 1376715029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 29847) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20042235A) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2019-08-12 |