| NPI | 1962648311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: OK 1070) |
| Additional Taxonomies | 103TP2701X Psychologist Group Psychotherapy (Licence: OK 1070) |
| 103TH0100X Psychologist Health Service (Licence: OK 1070) | |
| Enumeration Date | 2009-01-06 |
| Last Update Date | 2009-01-06 |