| NPI | 1962748657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: KS 2322) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MD 05224) |
| 103TC1900X Psychologist, Counseling (Licence: MO 2015010530) | |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2015-09-09 |