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 |