NPI | 1861465817 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20042996A) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY18983) |
Enumeration Date | 2006-02-09 |
Last Update Date | 2019-01-18 |