| NPI | 1730161910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN P0376) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AR 04-4P) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2007-07-08 |