| NPI | 1588071237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20043337B) |
| 103K00000X Behavior Analyst (Licence: IN 1-14-17462) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2025-03-26 |