| NPI | 1699748954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN P775) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA 1243) |
| 103G00000X Clinical Neuropsychologist (Licence: TN 775) | |
| 103G00000X Clinical Neuropsychologist (Licence: GA 1243) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TN 775) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: GA 1243) | |
| 103TF0000X Psychologist, Family (Licence: TN 775) | |
| 103TF0000X Psychologist, Family (Licence: GA 1243) | |
| 103TF0200X Psychologist, Forensic (Licence: TN 775) | |
| 103TF0200X Psychologist, Forensic (Licence: GA 1243) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2007-07-08 |