| NPI | 1215005988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IN 20042200A) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IN 39001752A) |
| 101YM0800X Counselor Mental Health (Licence: KY 163555) | |
| 103TC0700X Psychologist Clinical (Licence: KY 130408) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2018-09-13 |