| 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 |