| NPI | 1467950477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist Health Service |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IN 20043100A) |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2018-02-07 |