| NPI | 1740345438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN 2361) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TN 1472) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TN 2361) | |
| 103TC0700X Psychologist, Clinical (Licence: TN 2361) | |
| 103TC1900X Psychologist, Counseling (Licence: TN 2361) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TN 2361) | |
| Enumeration Date | 2006-12-25 |
| Last Update Date | 2021-08-02 |