NPI | 1588636963 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IN 20040418A) |
Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: IN 20040418A) |
Enumeration Date | 2006-02-01 |
Last Update Date | 2019-06-03 |