| NPI | 1902294374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: NH 1393) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: MA 10210) |
| Enumeration Date | 2015-01-07 |
| Last Update Date | 2022-07-21 |