| NPI | 1144636739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 1609-PY-PR-TEMP) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist (Licence: KS 02994) | |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2021-05-20 |