| NPI | 1962585026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: KY 222) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 222) |
| 103T00000X Psychologist (Licence: KY 222) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: KY 222) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: KY 222) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KY 222) | |
| 103TC0700X Psychologist, Clinical (Licence: KY 222) | |
| 103TC1900X Psychologist, Counseling (Licence: KY 222) | |
| 103TH0100X Psychologist, Health Service (Licence: KY 222) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-07-08 |