| 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 |