| NPI | 1518182716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KY 814) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TN 2628) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2007-07-08 |