| NPI | 1386711984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IN 2004-1203A) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 5386) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2016-01-14 |