| NPI | 1427388107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 2880) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TN 2880) |
| 103G00000X Clinical Neuropsychologist (Licence: TN 2880) | |
| Enumeration Date | 2010-01-02 |
| Last Update Date | 2010-01-02 |