| NPI | 1770591323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TN P0000002053) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: TN P000002053) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2010-04-20 |