| NPI | 1528609583 | 
|---|---|
| Former Name | KATHRYN WILLIAMS | 
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810006213)  | 
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 8010006213)  | 
| Enumeration Date | 2019-10-01 | 
| Last Update Date | 2025-01-09 |