| NPI | 1588147847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 5734) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 5734) |
| 103TC0700X Psychologist, Clinical (Licence: IN 20043163A) | |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2021-01-28 |