| NPI | 1801037841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AR 77-11P) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: AR 77-11P) |
| 103TH0100X Psychologist Health Service (Licence: AR 77-11P) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: AR 77-11P) | |
| Enumeration Date | 2009-03-22 |
| Last Update Date | 2009-03-22 |