| NPI | 1659826022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN 3933) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 174824) |
| 103T00000X Psychologist (Licence: KY 282219) | |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2023-09-20 |