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 |