| NPI | 1174604169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN P - 547) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TN P - 547) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TN P - 547) | |
| 106H00000X Marriage & Family Therapist (Licence: TN P - 547) | |
| 103TH0100X Psychologist, Health Service (Licence: TN P - 547) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2007-11-17 |