| NPI | 1689737181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN PE1378) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: 27004 NBCC) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2014-12-30 |