| NPI | 1972571776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20042056A) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY17420) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2016-01-07 |