| NPI | 1982632329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IN 20041616A) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: IN 20041616A) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: IN 20041616A) | |
| 103T00000X Psychologist (Licence: IN 20041616A) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2012-01-23 |