| NPI | 1639389174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20040719A) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071.004920) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2021-03-19 |