| NPI | 1649607557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810005151) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20042681A) |
| Enumeration Date | 2013-10-09 |
| Last Update Date | 2017-03-06 |