| NPI | 1083170690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 01548) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 2904) |
| Enumeration Date | 2019-02-19 |
| Last Update Date | 2025-04-21 |