| NPI | 1669015111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY10638) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20040648) |
| Enumeration Date | 2019-10-28 |
| Last Update Date | 2022-08-05 |