| NPI | 1649321258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 002913) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 017197-1) |
| 103TC0700X Psychologist, Clinical (Licence: IN 20042132) | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2009-04-07 |