| NPI | 1407821861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN P-933) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TN P-933) |
| 103TH0100X Psychologist, Health Service (Licence: TN P-933) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: TN P-933) | |
| 103TS0200X Psychologist, School (Licence: TN P-933) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2007-07-08 |