| NPI | 1013918796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: KS KS#767) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: KS 767) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2012-12-18 |