| NPI | 1750914321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 1351) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2006021325) |
| Enumeration Date | 2020-02-21 |
| Last Update Date | 2020-02-21 |