| NPI | 1376859785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301013955) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: IN 20090246QA) |
| Enumeration Date | 2010-08-23 |
| Last Update Date | 2010-09-01 |