| NPI | 1003859042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 1209) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 1209) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: KS 1209) | |
| 103TH0100X Psychologist, Health Service (Licence: KS 1209) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: KS 1209) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2021-12-20 |