| NPI | 1720307903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: AR 12-01E) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: AR 12-01E) |
| 103T00000X Psychologist (Licence: AR 12-01E) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AR 12-01E) | |
| 103TC0700X Psychologist, Clinical (Licence: AR 12-01E) | |
| 103TC1900X Psychologist, Counseling (Licence: AR 12-01E) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: AR 12-01E) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: AR 12-01E) | |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2018-08-16 |