| NPI | 1225068794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist Health Service (Licence: TN PE011566) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TN LPC00735) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2013-04-11 |