NPI | 1407857592 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20043011A) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY3770) |
103TF0000X Psychologist, Family (Licence: IN 20043011A) | |
Enumeration Date | 2005-08-10 |
Last Update Date | 2022-07-21 |