| NPI | 1215022702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 128993) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY KY 1540) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2018-09-07 |