| NPI | 1346393493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KY 1512) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 2007-4) |
| Enumeration Date | 2007-01-20 |
| Last Update Date | 2014-10-29 |