| NPI | 1851388805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist School (Licence: NH 26231) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NH 261) |
| 103T00000X Psychologist (Licence: NH 261) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: NH 261) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NH 261) | |
| 103TH0100X Psychologist Health Service (Licence: NH 261) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: NH 261) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2025-09-11 |