| NPI | 1780834390 |
|---|---|
| Other Name | PSYCH, INC |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AL 1723) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 103T00000X Psychologist (Licence: KY 1732) | |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2021-06-29 |