| NPI | 1780816900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20042617A) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IL 166.000724) |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2013-03-27 |