| NPI | 1114941572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 2781) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IN 20042019A) |
| 103T00000X Psychologist (Licence: WI 2781) | |
| 103TC0700X Psychologist, Clinical (Licence: IN 20042019A) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IN 20042019A) | |
| 103TF0200X Psychologist, Forensic (Licence: IN 20042019A) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-09-15 |