| NPI | 1730391749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WV 810) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WV 1620) |
| 103TC0700X Psychologist, Clinical (Licence: KY 1369) | |
| 103TC0700X Psychologist, Clinical (Licence: OH 7035) | |
| 103TC0700X Psychologist, Clinical (Licence: KY 128980) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2021-05-16 |