| NPI | 1851424766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: MI 6301004583) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: IN 20040082) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |