| NPI | 1639182694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: IN 20040656) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: IN 20040656) |
| 101YM0800X Counselor, Mental Health (Licence: IN 39001155) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2013-05-29 |