| NPI | 1538214853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY KY-100) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2025-09-11 |