| NPI | 1174623789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: OK 376) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2023-07-11 |