| NPI | 1508275348 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20042973B) | 
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist | 
| Enumeration Date | 2014-08-06 | 
| Last Update Date | 2025-09-02 |