| NPI | 1285634758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: TN P0000002200) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: TN P0000002200) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: TN P0000002200) | |
| 103TF0000X Psychologist Family (Licence: TN P0000002200) | |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2008-02-04 |