| NPI | 1700923703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: TN P0000001493) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: TN P0000001493) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2010-12-09 |