| NPI | 1659759793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: KS 2449) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 2449) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2023-09-08 |