| NPI | 1376827915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20041741A) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2019-06-26 |