NPI | 1942402367 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KY KY-0578) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY KY-0578) |
103TF0200X Psychologist, Forensic (Licence: KY KY-0578) | |
Enumeration Date | 2007-06-05 |
Last Update Date | 2014-01-30 |