| NPI | 1497124622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: KY 247368) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KY 247368) |
| 103TC0700X Psychologist, Clinical (Licence: KY 247368) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: KY 247368) | |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2019-06-18 |