| NPI | 1275505166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: KS 1917) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: OK 971) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2011-11-21 |