| 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 |