| NPI | 1336290022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN 3987) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: AZ 3809) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: AZ 3809) | |
| 103TC0700X Psychologist, Clinical (Licence: AZ 3809) | |
| 103TH0100X Psychologist, Health Service (Licence: TN 3987) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: TN 3987) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2024-01-27 |