| NPI | 1972650018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TN 520 SENIOR PSYCH EXM) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TN LEAP#97) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2008-04-01 |