| NPI | 1043315609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN P2021) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NC 3016) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2008-02-13 |