| NPI | 1073611554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KY 129179) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 1433) |
| 103TC1900X Psychologist, Counseling (Licence: KY 1433) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-04-10 |