| NPI | 1659831451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN 3543) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 103K00000X Behavior Analyst (Licence: 1-18-31686) | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-11-12 |