| NPI | 1881682649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: KS LP1129) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MO 2001024797) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2021-06-15 |