| NPI | 1568422095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN P773) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MS 29406) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2007-07-08 |