| NPI | 1750352548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN PSY3020) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 107991) |
| 103T00000X Psychologist (Licence: TN PSY3020) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2012-09-28 |