| NPI | 1265663678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: IN 20043521A) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 8939) |
| 103T00000X Psychologist (Licence: NE 812) | |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2022-01-26 |