| NPI | 1184649402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 128987) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY 0810) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2022-07-21 |