| NPI | 1770660888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 0721) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: KY 0721) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: KY 0721) | |
| 103TF0000X Psychologist, Family (Licence: KY 0721) | |
| 103T00000X Psychologist (Licence: KY 0721) | |
| 106H00000X Marriage & Family Therapist (Licence: KY 0035) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |