| NPI | 1831220920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN 2763) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TN 2763) |
| 103TS0200X Psychologist, School (Licence: TN P2763) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2011-09-15 |