| NPI | 1942238647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 04745) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TN P0000002648) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2011-04-07 |