| NPI | 1144340886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY KY-0931) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20041619A) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2007-07-08 |