| 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 |