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 |