| NPI | 1558698357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20042736A) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39001609A) |
| Enumeration Date | 2009-11-16 |
| Last Update Date | 2014-02-14 |