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 |