| NPI | 1457632416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN P3570) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 103T00000X Psychologist | |
| 103TC0700X Psychologist, Clinical (Licence: TN 3570) | |
| Enumeration Date | 2011-09-05 |
| Last Update Date | 2025-06-17 |