| NPI | 1790887669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IN 20040651A) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP5573) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: IN 20040651A) | |
| 103TC0700X Psychologist Clinical (Licence: IN 20040651A) | |
| 103TC1900X Psychologist Counseling (Licence: IN 20040651A) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: IN 20040651A) | |
| 103TF0200X Psychologist Forensic (Licence: IN 20040651A) | |
| 103TH0100X Psychologist Health Service (Licence: IN 20040651A) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: IN 20040651A) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: IN 20040651A) | |
| 103TR0400X Psychologist Rehabilitation (Licence: IN 20040651A) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2025-07-01 |