| NPI | 1871588855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN P000577) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: TN P000577) |
| 103TF0000X Psychologist Family (Licence: TN P000577) | |
| 103TF0200X Psychologist Forensic (Licence: TN P000577) | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2011-10-13 |