| NPI | 1598784027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN P551) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AR 78-24P) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2011-11-22 |