| NPI | 1538494273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: TN P0000000266) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TN P0000000266) |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2009-10-14 |