| NPI | 1013214113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AR 84-03LPE-I) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AR 84-03LPE-I) |
| 103TC0700X Psychologist, Clinical (Licence: AR 84-03LPE-I) | |
| 103TC1900X Psychologist, Counseling (Licence: AR 84-03LPE-I) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AR 84-03LPE-I) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: AR 84-03LPE-I) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: AR 44-03LPE-I) | |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2011-02-25 |