| NPI | 1053737890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KY KY-1387) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IN 20042144A) |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2014-03-17 |