| NPI | 1720109382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY001858) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TN P0000001857) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2007-07-09 |