| NPI | 1578734109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0000X Psychologist Family (Licence: TN P377) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: TN P377) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: TN P377) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: TN P377) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: TN P377) | |
| 103TS0200X Psychologist School (Licence: TN P377) | |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2008-03-24 |