| NPI | 1316534480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 295528) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 266421) |
| Enumeration Date | 2020-12-23 |
| Last Update Date | 2024-10-17 |