| NPI | 1982757381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 36277) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20042430A) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY23301) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2012-10-04 |