| NPI | 1205261542 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 2533) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KS 2533) |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2018-04-06 |