| NPI | 1285837369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KY 129668) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: KY 1721) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2018-04-13 |