| NPI | 1265820211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 1314) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: KY 1314) |
| Enumeration Date | 2014-12-29 |
| Last Update Date | 2014-12-29 |