| NPI | 1649580911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 36719) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IN 20042453A) |
| 103T00000X Psychologist (Licence: TX 36719) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IN 20042453A) | |
| 103TC0700X Psychologist, Clinical (Licence: IN 20042453A) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: IN 20042453A) | |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2023-05-09 |