| NPI | 1801853536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MS 30452) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TN P1341) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2020-01-03 |