| NPI | 1720207095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KY 1097) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: KY 1097) |
| 103TH0100X Psychologist, Health Service (Licence: KY 1097) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2007-07-08 |