| NPI | 1659621936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN 3740) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS017131) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS017131) | |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2022-03-21 |