| NPI | 1467444125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 130491) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: KY 1330) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2018-04-17 |