| NPI | 1720006281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN P0000001519) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TN P0000001519) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |