| NPI | 1215307541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NH 1662) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NH 1662) |
| 103TC1900X Psychologist, Counseling (Licence: 1662) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NH 1662) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2023-07-17 |