| NPI | 1609442607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 4030) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 4030) |
| 103TC0700X Psychologist, Clinical (Licence: IN 20043360A) | |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2024-10-17 |