| NPI | 1649322108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS LMLP0161) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS LCP234) |
| 106H00000X Marriage & Family Therapist (Licence: KS LCMFT121) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2013-04-03 |