| NPI | 1740257021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20040582) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IN 20040582) |
| 103T00000X Psychologist (Licence: TX 33522) | |
| 103TC0700X Psychologist, Clinical (Licence: TX 33522) | |
| Enumeration Date | 2006-03-04 |
| Last Update Date | 2008-10-29 |