| NPI | 1780066407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 5999) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IN 20042669A) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2024-09-30 |