| NPI | 1679855209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IN 20042930A) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical (Licence: IL 071.009367) | |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2017-02-14 |