| NPI | 1679914121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3612) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810005777) |
| 103TC0700X Psychologist, Clinical (Licence: TN P-2994) | |
| Enumeration Date | 2013-07-12 |
| Last Update Date | 2024-02-16 |