| NPI | 1346313061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: KS 1397) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MO 2002002936) |
| 103TC1900X Psychologist, Counseling (Licence: KS 1166) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2025-11-18 |