| NPI | 1598019838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL 9065) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20043323B) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2023-05-18 |