| NPI | 1578698460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN P969) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MS 366) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2021-03-29 |