| NPI | 1669897872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20042771A) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 1758) |
| 103K00000X Behavior Analyst | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IN 20042771A) | |
| Enumeration Date | 2014-02-25 |
| Last Update Date | 2022-05-23 |