| NPI | 1437763018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20043365A) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY 263320) |
| 103TC1900X Psychologist, Counseling (Licence: IN 20043365A) | |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2020-09-18 |