| NPI | 1902873698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 909) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 777) |
| 101YP2500X Counselor, Professional (Licence: MO 2009034544) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2011-02-10 |