| NPI | 1447379227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KY KY-0493) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY 115928) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2018-04-08 |