| NPI | 1407075609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN P1522) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: TN P1522) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2007-07-08 |