| NPI | 1023271442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 261182) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TC1900X Psychologist, Counseling (Licence: KY 261182) | |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2024-03-05 |