| NPI | 1528176427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS LP-0344) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO R0085) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-07-08 |