| NPI | 1184763229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MS 30447) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MS 30447) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TN 1381) | |
| 103T00000X Psychologist (Licence: TN 1381) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2012-06-06 |