| NPI | 1093920894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: KY 129219) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: KY 1337) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2018-02-01 |