| NPI | 1013387687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN P0000003473) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2015033025) |
| Enumeration Date | 2015-09-25 |
| Last Update Date | 2018-03-21 |