| NPI | 1992804405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 011) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TN 264) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2025-09-11 |