| NPI | 1659426955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN P2026) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TN P2026) |
| 103T00000X Psychologist (Licence: MA PSY5000037) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2025-07-28 |