| NPI | 1730494394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OK 537) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OK LBP0165) |
| Enumeration Date | 2010-08-07 |
| Last Update Date | 2015-02-24 |