| NPI | 1093992919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 1480) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 1149) |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2018-06-11 |