NPI | 1043578123 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: TN 7696871) |
Additional Taxonomies | 101YS0200X Counselor, School (Licence: TN 7147485) |
103TC0700X Psychologist, Clinical (Licence: TN 7137531) | |
103TS0200X Psychologist, School (Licence: TN 7147485) | |
Enumeration Date | 2012-04-26 |
Last Update Date | 2012-04-26 |