| NPI | 1679699151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20010430A) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 5174) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2007-07-08 |