| NPI | 1801167937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IN 20042565A) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IN 20042565A) |
| Enumeration Date | 2012-01-20 |
| Last Update Date | 2012-01-20 |