| NPI | 1083768741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KS LMLP0047) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS LCP206) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-08 |