| NPI | 1114082245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS LMLP 0702) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS LCP333) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2007-07-08 |