| NPI | 1982800496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 31973) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071-006115) |
| 103TH0004X Psychologist, Health (Licence: IN 20041521) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2016-06-27 |