| NPI | 1861625030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OK 1378) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OK 3669) |
| Enumeration Date | 2009-09-03 |
| Last Update Date | 2024-07-25 |