| NPI | 1790785723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN P0000001092) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: TN P0000001092) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: TN P0000001092) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: TN P0000001092) | |
| 103TF0000X Psychologist Family (Licence: TN P0000001092) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: TN P0000001092) | |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2008-02-04 |