NPI | 1700408036 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TN P1289) |
103TS0200X Psychologist, School | |
Enumeration Date | 2020-05-08 |
Last Update Date | 2020-05-08 |