| NPI | 1235166604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: KS 1260) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 054) |
| 103T00000X Psychologist (Licence: KS 1260) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2020-03-11 |