| NPI | 1750509667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20041856a) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: IN 20041856A) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2008-12-12 |