| NPI | 1730152547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 1900) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20010320A) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2018-12-27 |