| NPI | 1164504494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN 2786) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TN 2038) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2012-01-11 |