| NPI | 1679924138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.07653) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20043347A) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2022-07-21 |