| NPI | 1811190952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: TN PE0000000616) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TN PE0000000616) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: TN PE0000000616) | |
| 103TS0200X Psychologist, School (Licence: TN PE0000000616) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2007-07-08 |