| NPI | 1871694232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS017050) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20042242A) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2011-12-05 |