| NPI | 1467476150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN P0000001029) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TN CMT0000000186) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-07-08 |