| NPI | 1346298866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN P2278) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TN P2278) |
| 103TC0700X Psychologist, Clinical (Licence: ID PSY-202526) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TN P2278) | |
| 103TH0100X Psychologist, Health Service (Licence: TN P2278) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2019-08-15 |