| NPI | 1700881356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: KY 1568) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY 1568) |
| 106H00000X Marriage & Family Therapist (Licence: KY 1568) | |
| Enumeration Date | 2005-06-19 |
| Last Update Date | 2011-05-10 |