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, Intellectual & Developmental Disabilities (Licence: TN P0000001092) | |
Enumeration Date | 2005-08-01 |
Last Update Date | 2008-02-04 |