| NPI | 1356474639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: TN PE1585) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TN LPC790) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2012-02-22 |