| NPI | 1164665378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20041452A) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: IN 20041452A) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: IN 20041452A) | |
| Enumeration Date | 2009-04-17 |
| Last Update Date | 2009-04-17 |