| NPI | 1164888509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: TN 3318) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TN 3318) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TN 3318) | |
| 103TC1900X Psychologist, Counseling (Licence: TN 3318) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: TN 3318) | |
| Enumeration Date | 2016-01-14 |
| Last Update Date | 2024-01-24 |