| NPI | 1154723286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 277927) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 171133) |
| Enumeration Date | 2014-09-19 |
| Last Update Date | 2024-08-01 |