| NPI | 1831497783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM 1279) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IN 99045855A) |
| 103TC1900X Psychologist, Counseling (Licence: NM 1279) | |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2023-06-27 |