| NPI | 1245486745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 129918) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 129918) |
| 103T00000X Psychologist (Licence: KY 129918) | |
| 103TC1900X Psychologist, Counseling (Licence: KY 129918) | |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2024-08-26 |