| NPI | 1407324270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN 3671) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: FL PY10328) |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2022-03-28 |