| NPI | 1023112695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 338) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 827) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2025-09-11 |