| NPI | 1649361957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: TN P0000000894) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TN 894) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2025-09-10 |