| NPI | 1639127558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KY 114440) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KY 0043) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2020-11-18 |