| NPI | 1558795500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 2550) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KS 2394) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2022-10-24 |