| NPI | 1851428460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 04888) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IN 20042437A) |
| 101YM0800X Counselor, Mental Health (Licence: IN 39001937A) | |
| 101YM0800X Counselor, Mental Health (Licence: FL MH 7447) | |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2010-11-22 |