| NPI | 1659326239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KY 078) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: KY 0135) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2008-05-27 |