| NPI | 1497965917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AR 04-08P) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: AR 04-08P) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AR 04-08P) | |
| 103TC1900X Psychologist, Counseling (Licence: AR 04-08P) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: AR 04-08P) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |