| NPI | 1023060605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS LCP 209) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS LMLP 0271) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2017-01-09 |