| NPI | 1265625388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN 3095) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: VA 0810004310) |
| 103TC0700X Psychologist Clinical (Licence: TN 0000003095) | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2021-12-01 |