| NPI | 1669573770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 128960) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: KY 1200) |
| 103TH0100X Psychologist, Health Service (Licence: KY 1200) | |
| 103TH0004X Psychologist, Health (Licence: KY 128960) | |
| 103TH0100X Psychologist, Health Service (Licence: KY 128960) | |
| 103TC0700X Psychologist, Clinical (Licence: KY 1200) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-11-18 |