| NPI | 1861762437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NH 1288) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NH 1288) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2018-04-12 |