| NPI | 1609896653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IN 20042287A) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IN 20042287A) |
| 103TC0700X Psychologist, Clinical (Licence: IN 20042287A) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2019-01-02 |