| NPI | 1508876392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 709) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20040433A) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2014-12-18 |