| NPI | 1881790624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 142) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KS 046) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2007-07-08 |