| NPI | 1922673136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 13820914-2501) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 103406) |
| 103T00000X Psychologist (Licence: SC 1873) | |
| 103T00000X Psychologist (Licence: TN 4040) | |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2024-10-08 |