| NPI | 1700325453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 2506) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS 2114) |
| Enumeration Date | 2017-02-14 |
| Last Update Date | 2017-02-14 |