| NPI | 1942212097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OK 540) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC1900X Psychologist Counseling (Licence: OK 540) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: OK 540) | |
| 103TE1100X Psychologist Exercise & Sports (Licence: OK 540) | |
| 103TF0000X Psychologist Family (Licence: OK 540) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2017-06-01 |