| NPI | 1164067518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TN 3222) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TN 3222) |
| 103TH0100X Psychologist, Health Service (Licence: TN 3222) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: TN 3222) | |
| Enumeration Date | 2019-11-08 |
| Last Update Date | 2020-01-07 |