| NPI | 1992081053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: KS 03259) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CO 0005599) |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2023-11-03 |