| NPI | 1134172562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 2708) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: TN P2708) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2020-05-30 |