| NPI | 1356010862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 281597) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 271738) |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2023-01-02 |