| NPI | 1750360624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY ky 0215) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20010039a) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2011-01-05 |